The Food and Drug Administration revealed nine graphic images Tuesday that will act as warning labels on every pack of cigarettes sold in the United States.
The new warning labels will appear prominently on the cigarette packs, displaying large, graphic images and written warnings about the dangers of smoking. The law represents the most significant change to cigarette labels in 25 years.
The images vary from diseased lungs, to decayed teeth to a baby breathing in cigarette smoke. One displays a corpse with staples running down its chest, and another shows smoke billowing out of a tracheotomy tube in a man's neck.
Warnings such as "Smoking can kill you," and "Cigarettes cause fatal lung disease" appear with each picture.
"These labels are frank, honest and powerful depictions of the health risks of smoking," Health and Human Services Secretary Kathleen Sebelius said in a statement.
The warning must be displayed on the top half of the front and rear panel of each cigarette pack.
Cigarette manufacturers have until September 2012 to comply with the regulation. Several manufacturers have challenged the law, alleging that the labels violate the First Amendment.
The FDA picked the nine images out of 36 possible pictures. FDA spokesman Jeff Ventura said the images were chosen based on an 18,000-person study and thousands of comments from various interest groups.
"These images ranked highest in several categories used to evaluate the images for effectiveness," Mr. Ventura said.
"From a public health standpoint, this is a good thing."
The introduction of graphic warning labels was required in a 2009 law that, for the first time, gave the federal government authority to regulate tobacco. Tuesday's announcement follows reviews of scientific literature, public comments and results from an FDA-contracted study of 36 labels proposed last November.
The U.S. first mandated the use of warning labels stating "Cigarettes may be hazardous to your health" in 1965. The current warning labels -- put on cigarette packs in the mid-1980s -- say more explicitly that smoking can cause lung cancer, heart disease and other illnesses. But the warnings contain no pictures; they consist only of text in a small box.
The FDA estimates the new labels will decrease the number of smokers by about 200,000 in 2013, with smaller reductions continuing through 2031. Currently, about 46 million U.S. adults smoke cigarettes.
Brian Carlin, a physician practicing pulmonary medicine and critical care in Pittsburgh, said he believed that the new warning labels would be effective.
"People will start seeing, in real time, pictures of how smoking will affect them in the long run," he said.
Dr. Carlin regularly treats smokers suffering from lung cancer, emphysema and other smoking-related ailments.
"They're going to see [the images] 100 times a week and hopefully seek help somewhere along the line," he said.
Dr. Carlin said a pack-a-day smoker would see the warning images 7,000 times in a year.
Some local smokers expressed outrage at the new law while others were indifferent, but most said the graphic labels wouldn't change their habit.
Gesturing to an image depicting cigarette smoke enveloping a baby, Elizabeth Luna, a longtime smoker from East Liberty, said adamantly that she did not smoke around her grandchildren.
The image's warning label reads: "Tobacco smoke can harm your children."
Ms. Luna said the new warnings were intrusive.
"This is too much. I can smoke. It's my right," Ms. Luna said. "I didn't smoke when I carried my children. I don't smoke around my grandchildren."
Ross Fowler of Mount Washington has been a smoker for about five years.
"I'm going to smoke no matter what. I know it's slowly killing me but it's addictive," Mr. Fowler said.
Yet some smokers said the warning label could have a positive effect.
Alan Gavolas of Mount Washington said the new labels could help prevent teenagers from smoking.
"I think older people are set in their ways, and if they're going to quit, it will be in their own time," he said. "But I think it will affect the younger crowd that just smokes on weekends."
Latasha Howard of Hazelwood said she had health problems related to her smoking habit.
"If you're going to smoke, you should be aware of what you're getting into," Ms. Howard said.
More than 30 countries have introduced similar warning labels on cigarette packs. Smoking rates in Canada have declined about 6 percent since 2000 when the country instituted graphic warning labels.
Madeline Buckley: firstname.lastname@example.org . The Associated Press contributed to this report.